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The Bone & Joint Journal Jan 2018To present a surgically relevant update of trunnionosis. (Review)
Review
AIMS
To present a surgically relevant update of trunnionosis.
MATERIALS AND METHODS
Systematic review performed April 2017.
RESULTS
Trunnionosis accounts for approximately 2% of the revision total hip arthroplasty (THA) burden. Thinner (reduced flexural rigidity) and shorter trunnions (reduced contact area at the taper junction) may contribute to mechanically assisted corrosion, exacerbated by high offset implants. The contribution of large heads and mixed metallurgy is discussed.
CONCLUSION
Identifying causative risk factors is challenging due to the multifactorial nature of this problem. Cite this article: 2018;100-B(1 Supple A):44-9.
Topics: Arthroplasty, Replacement, Hip; Corrosion; Hip Prosthesis; Humans; Prosthesis Design; Prosthesis Failure; Reoperation; Risk Factors
PubMed: 29292339
DOI: 10.1302/0301-620X.100B1.BJJ-2017-0569.R1 -
Acta Orthopaedica 2015Few studies have addressed the association between early migration of femoral stems and late aseptic revision in total hip arthroplasty. We performed a meta-regression... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
Few studies have addressed the association between early migration of femoral stems and late aseptic revision in total hip arthroplasty. We performed a meta-regression analysis on 2 parallel systematic reviews and meta-analyses to determine the association between early migration and late aseptic revision of femoral stems.
PATIENTS AND METHODS
Of the 2 reviews, one covered early migration data obtained from radiostereometric analysis (RSA) studies and the other covered long-term aseptic revision rates obtained from survival studies with endpoint revision for aseptic loosening. Stems were stratified according to the design concept: cemented shape-closed, cemented force-closed, and uncemented. A weighted regression model was used to assess the association between early migration and late aseptic revision, and to correct for confounders. Thresholds for acceptable and unacceptable migration were determined in accordance with the national joint registries (≤ 5% revision at 10 years) and the NICE criteria (≤ 10% revision at 10 years).
RESULTS
24 studies (731 stems) were included in the RSA review and 56 studies (20,599 stems) were included in the survival analysis review. Combining both reviews for the 3 design concepts showed that for every 0.1-mm increase in 2-year subsidence, as measured with RSA, there was a 4% increase in revision rate for the shape-closed stem designs. This association remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. The threshold for acceptable migration of shape-closed designs was defined at 0.15 mm; stems subsiding less than 0.15 mm in 2 years had revision rates of less than 5% at 10 years, while stems exceeding 0.15 mm subsidence had revision rates of more than 5%.
INTERPRETATION
There was a clinically relevant association between early subsidence of shape-closed femoral stems and late revision for aseptic loosening. This association can be used to assess the safety of shape-closed stem designs. The published research is not sufficient to allow us to make any conclusions regarding such an association for the force-closed and uncemented stems.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Prosthesis Design; Prosthesis Failure; Radiostereometric Analysis; Reoperation; Risk Factors; Treatment Outcome
PubMed: 25909455
DOI: 10.3109/17453674.2015.1043832 -
The Journal of Arthroplasty Jul 2024The rise of periprosthetic joint infections (PJIs) due to aging populations is steadily increasing the number of arthroplasties and treatment costs. This study analyzed...
BACKGROUND
The rise of periprosthetic joint infections (PJIs) due to aging populations is steadily increasing the number of arthroplasties and treatment costs. This study analyzed the direct health care costs of PJI for total hip arthroplasty and total knee arthroplasty (TKA) in Europe.
METHODS
The databases PubMed, Scopus, Embase, Cochrane, and Google Scholar were systematically screened for direct costs of PJI in Europe. Publications that defined the joint site and the procedure performed were further analyzed. Mean direct health care costs were calculated for debridement, antibiotics, and implant retention (DAIR), one-stage, and 2-stage revisions for hip and knee PJI, respectively. Costs were adjusted for inflation rates and reported in US-Dollar (USD).
RESULTS
Of 1,374 eligible publications, 12 manuscripts were included in the final analysis after an abstract and full-text review. Mean direct costs of $32,933 were identified for all types of revision procedures for knee PJI. The mean direct treatment cost including DAIR for TKA after PJI was $19,476. For 2-stage revisions of TKA, the mean total cost was $37,980. For all types of hip PJI procedures, mean direct hospital costs were $28,904. For hip DAIR, one-stage and 2-stage treatment average costs of $7,120, $44,594, and $42,166 were identified, respectively.
CONCLUSIONS
Periprosthetic joint infections are associated with substantial direct health care costs. As detailed reports on the cost of PJI are scarce and of limited quality, more detailed financial data on the cost of PJI treatment are urgently required.
Topics: Humans; Prosthesis-Related Infections; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Europe; Hospital Costs; Reoperation; Hip Prosthesis; Knee Prosthesis; Anti-Bacterial Agents; Debridement
PubMed: 38266688
DOI: 10.1016/j.arth.2024.01.032 -
Clinics in Orthopedic Surgery Sep 2016Different implant designs are utilized in reverse shoulder arthroplasty. The purpose of this systematic review was to evaluate the results of reverse shoulder... (Review)
Review
BACKGROUND
Different implant designs are utilized in reverse shoulder arthroplasty. The purpose of this systematic review was to evaluate the results of reverse shoulder arthroplasty using a traditional (Grammont) prosthesis and a lateralized prosthesis for the treatment of cuff tear arthropathy and massive irreparable rotator cuff tears.
METHODS
A systematic review of the literature was performed via a search of two electronic databases. Two reviewers evaluated the quality of methodology and retrieved data from each included study. In cases where the outcomes data were similar between studies, the data were pooled using frequency-weighted mean values to generate summary outcomes.
RESULTS
Thirteen studies met the inclusion and exclusion criteria. Demographics were similar between treatment groups. The frequency-weighted mean active external rotation was 24° in the traditional group and 46° in the lateralized group (p = 0.0001). Scapular notching was noted in 44.9% of patients in the traditional group compared to 5.4% of patients in the lateralized group (p = 0.0001). The rate of clinically significant glenoid loosening was 1.8% in the traditional group and 8.8% in the lateralized group (p = 0.003).
CONCLUSIONS
Both the traditional Grammont and the lateralized offset reverse arthroplasty designs can improve pain and function in patients with diagnoses of cuff tear arthropathy and irreparable rotator cuff tear. While a lateralized design can result in increased active external rotation and decreased rates of scapular notching, there may be a higher rate of glenoid baseplate loosening.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement; Female; Humans; Male; Middle Aged; Postoperative Complications; Prosthesis Design; Rotator Cuff; Shoulder Prosthesis; Treatment Outcome
PubMed: 27583112
DOI: 10.4055/cios.2016.8.3.288 -
The Journal of Bone and Joint Surgery.... Aug 2012We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement... (Meta-Analysis)
Meta-Analysis Review
We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95% confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.
Topics: Arthroplasty, Replacement; Humans; Hypersensitivity; Joint Prosthesis; Metals; Preoperative Period; Prosthesis Failure; Skin Tests
PubMed: 22844057
DOI: 10.1302/0301-620X.94B8.28135 -
International Orthopaedics Dec 2023This systematic review and meta-analysis aimed to compare the outcomes of THA in patients with osteonecrosis (ON) and those with osteoarthritis (OA). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review and meta-analysis aimed to compare the outcomes of THA in patients with osteonecrosis (ON) and those with osteoarthritis (OA).
METHODS
Four databases were searched from inception till December 2022 for original studies that compared the outcomes of THA in ON and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and Harris hip score. This review was conducted in line with PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale.
RESULTS
A total of 14 observational studies with 2,111,102 hips were included, with a mean age of 50.83 ± 9.32 and 55.51 ± 8.95 for ON and OA groups, respectively. The average follow-up was 7.25 ± 4.6 years. There was a statistically significant difference in revision rate between ON and OA patients in favour of OA (OR: 1.576; 95%CI: 1.24-2.00; p-value: 0.0015). However, dislocation rate (OR: 1.5004; 95%CI: 0.92-2.43; p-value: 0.0916) and Haris hip score (HHS) (SMD: - 0.0486; 95%CI: - 0.35-0.25; p-value: 0.6987) were comparable across both groups. Further sub-analysis adjusting for registry data also showed similar results between both groups.
CONCLUSION
A higher revision rate, periprosthetic fracture and periprosthetic joint infection following total hip arthroplasty were associated with osteonecrosis of the femoral head compared with osteoarthritis. However, both groups had similar dislocation rates and functional outcome measures. This finding should be applied in context due to potential confounding factors, including patient's age and activity level.
Topics: Humans; Adult; Middle Aged; Arthroplasty, Replacement, Hip; Osteonecrosis; Osteoarthritis; Joint Dislocations; Periprosthetic Fractures; Reoperation; Hip Prosthesis; Treatment Outcome; Retrospective Studies; Osteoarthritis, Hip
PubMed: 36905418
DOI: 10.1007/s00264-023-05761-6 -
Foot and Ankle Surgery : Official... Sep 2013There are few records for total ankle replacement (TAR) in Asia. We aimed to report the cumulative intermediate-term outcomes in terms of clinical scores, survivorship... (Review)
Review
BACKGROUND
There are few records for total ankle replacement (TAR) in Asia. We aimed to report the cumulative intermediate-term outcomes in terms of clinical scores, survivorship and failure rates for patients managed with TAR in Asia.
METHODS
We conducted a systematic search for relevant articles published in English and other languages between January 1990 and February 2012. The study published before 1990 and used outdated prosthesis designs implanted before the early 1980s was excluded. Eligible studies were evaluated using the Coleman Methodology Score and data collection was independently performed by three reviewers.
RESULTS
Seven studies qualified for analysis, describing 321 implants (112 HINTEGRA(®), 104 TNK, 35 STAR, 13 ND-Bioceram, 57 un-reported implants). Overall studies showed the improvement of clinical scores following TAR. Pooled data for the survivorship analysis ranged from 100% at 3.2 years to 77% at 14.1 years. Pooled mean failure rate was 4.9±3.2% over a mean follow-up of 5.2±1.7 years.
CONCLUSIONS
TAR prostheses currently used in Asia achieved satisfactory intermediate-term outcomes in terms of clinical scores, survivorship and failure rates.
Topics: Ankle Joint; Arthroplasty, Replacement, Ankle; Follow-Up Studies; Humans; Joint Prosthesis; Osteoarthritis; Prosthesis Failure
PubMed: 23830161
DOI: 10.1016/j.fas.2013.04.005 -
The Bone & Joint Journal Sep 2013Mobile-bearing (MB) total knee replacement (TKR) was introduced to reduce the risk of aseptic loosening and wear of polyethylene inserts. However, no consistent clinical... (Comparative Study)
Comparative Study Meta-Analysis Review
Mobile-bearing (MB) total knee replacement (TKR) was introduced to reduce the risk of aseptic loosening and wear of polyethylene inserts. However, no consistent clinical advantages of mobile- over fixed-bearing (FB) TKR have been found. In this study we evaluated whether mobile bearings have an advantage over fixed bearings with regard to revision rates and clinical outcome scores. Furthermore, we determined which modifying variables affected the outcome. A systematic search of the literature was conducted to collect clinical trials comparing MB and FB in primary TKR. The primary outcomes were revision rates for any reason, aseptic loosening and wear. Secondary outcomes included range of movement, Knee Society score (KSS), Oxford knee score (OKS), Short-Form 12 (SF-12) score and radiological parameters. Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1827 publications, of which 41 studies met our inclusion criteria, comprising over 6000 TKRs. Meta-analyses showed no clinically relevant differences in terms of revision rates, clinical outcome scores or patient-reported outcome measures between MB and FB TKRs. It appears that theoretical assumptions of superiority of MB over FB TKR are not borne out in clinical practice.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Osteoarthritis, Knee; Patient Satisfaction; Prosthesis Design; Prosthesis Failure; Randomized Controlled Trials as Topic; Reoperation; Treatment Outcome
PubMed: 23997134
DOI: 10.1302/0301-620X.95B9.30386 -
The Journal of Hand Surgery Mar 2020Hand function is inseparably linked to the condition of the thumb. The trapeziometacarpal (TMC) joint that provides the different movements of opposition is one of the... (Review)
Review
Hand function is inseparably linked to the condition of the thumb. The trapeziometacarpal (TMC) joint that provides the different movements of opposition is one of the joints most affected by osteoarthritis, which causes an irreversible deformation of the bone. The ideal thumb carpometacarpal implant must restore range of movement, prevent complications, be biocompatible, and have good mechanical properties (ie, low wear, high corrosion resistance, and osteointegration properties where it is anchored in a bone). The integrity of the implant and the surrounding biological structures must be long-lasting and withstand constant stresses induced by the prosthesis. Three main types of implant systems for the thumb are currently clinically available; others are under investigation in human subjects. This systematic review is based on administrative databases, patents, the literature, and information from orthopedic companies. It provides a summary of strategies and design changes and an overview of the biomechanical characteristics of currently available carpometacarpal implants for treating osteoarthritis of the thumb.
Topics: Arthroplasty, Replacement; Carpometacarpal Joints; Humans; Joint Prosthesis; Range of Motion, Articular; Thumb; Trapezium Bone
PubMed: 31987639
DOI: 10.1016/j.jhsa.2019.11.015 -
The Knee Jan 2022Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily... (Review)
Review
BACKGROUND
Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily functional activities and clinical tests, but it remains unclear whether such movement characteristics hold the potential to indicate the underlying aetiology of unsatisfactory or bad TKA outcomes.
PURPOSE
To investigate which kinematic and kinetic parameters assessed during passive clinical tests and functional activities of daily living are associated with poor functionality and underlying deficits after total knee replacement.
METHODS
We focused on studies characterizing the kinematic or kinetic parameters of the knee joint that are associated with poor clinical outcome after TKA. Seventeen articles were included for the review, and kinematic and kinetic data from 719 patients with minimal follow up of 6 months were extracted and analyzed.
RESULTS
Passive posterior translation at 90°flexionexhibited good potential for differentiating stable and unstable TKAs. Anterior-posterior (A-P) translation of the medial condyle at 0-30° and 30-60° flexion, A-P translation of the lateral condyle at 60-90°during closed chain exercises, as well asknee extension moment during stair ascent and descent, knee abduction moment during stair descent, knee internal rotation moment and plantar flexion moment during walking, 2ndpeak ground reaction force during stair ascent and walkingshowed the greatest promise as functional biomarkers for a dissatisfied/poor outcome knee after TKA.
CONCLUSION
In this study, we systematically reviewed the state-of-the-art knowledge of kinematics and kinetics associated with functional deficits, and found 11 biomechanical parameters that showed promise for supportingdecision making in TKA.
Topics: Activities of Daily Living; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Humans; Kinetics; Knee Joint; Knee Prosthesis; Range of Motion, Articular
PubMed: 34883331
DOI: 10.1016/j.knee.2021.11.002